Mejoría de la adherencia a la dieta mediterránea en preescolares asistentes al jardín infantil / Improvement in adherence to Mediterranean diet in children attending preschool centers

Introducción: la dieta mediterránea se ha asociado a menor prevalencia de obesidad y síndrome metabólico y a estilos de vida saludable enadultos y escolares, siendo escasa la información en edades menores. La región central de Chile tiene un ecosistema de tipo mediterráneo, loque, junto con su gastronomía tradicional, facilitaría la adopción de este estilo de alimentación.Objetivos: determinar la adherencia a la dieta mediterránea en preescolares y sus padres y evaluar el impacto de una intervención educativay su implementación.Métodos: estudio de cohorte prospectiva. Se aplicaron los índices KidMed en niños/as mayores de 18 meses y el índice Chileno de DietaMediterránea (IDM-Chile) en los padres, antes y después de una intervención educativa remota.Resultados: participaron 139 familias, con 95 preescolares, 56 % mujeres, con edad de 26,2 ± 8,7 meses. Inicialmente, el KidMed en los niñosfue de 7,4 ± 1,9 puntos y aumentó hasta 7,9 ± 1,9 puntos postintervención (p = 0,1). El IDM-Chile en los padres fue de 6,9 ± 1,8 y 7,1 ± 1,7puntos, respectivamente (p = 0,09). Al separar por categorías, hubo mejoría desde una adherencia baja o moderada hacia una óptima en losniños y adultos (Chi2, p = 0,009 y p = 0,04). En 58 diadas hubo una correlación positiva entre los índices KidMed e IDM-Chile preintervencióny postintervención (R Pearson: 0,3 y 0,34; p = 0,004 y 0,003, respectivamente).Conclusiones: la mayoría de esta muestra de preescolares y sus padres presentaron una adherencia moderada a dieta mediterránea, con unamejoría posterior a la intervención educativa.(AU)

Background: the Mediterranean diet has been associated with a lower prevalence of obesity and metabolic syndrome, and with healthierlifestyles in adults and children, but data is scarce in younger ages. The Mediterranean-type ecosystem of the central region of Chile as well asits traditional gastronomy would facilitate the adoption of this dietary pattern.Objectives: to assess the adherence to Mediterranean diet in preschoolers and their parents, and to evaluate the impact of a nutrition educationintervention and diet implementation.Methods: prospective cohort study. The KidMed index was applied to children older than 18 months, and the Mediterranean Dietary Index inChile (Chilean-MDI) to their parents, before and after a remote educational intervention.Results: one hundred and thirty-nine families participated, with 95 preschoolers; 56 % were girls, aged 26.2 ± 8.7 months. The basal meanKidMed score was 7.4 ± 1.9 and increased to 7.9 ± 1.9 after the intervention (p = 0.1). The Chilean-MDI score was 6.9 ± 1.8 and 7.1 ± 1.7,respectively (p = 0.09). When separated by categories, there was improvement from low and moderate adherence to optimal adherence in bothchildren and their parents (Chi2, p = 0.009 y p = 0.04). In 58 dyads, there was a positive correlation between the KidMed and the Chilean-MDIindex, pre- and post-intervention (Pearson R = 0.3 y 0.34; p = 0.004 y 0.003, respectively).Conclusions: most of these sample of preschoolers and their parents had a moderate adherence to Mediterranean diet, with an improvementafter an educational intervention.(AU)

Limitaciones y oportunidades para la adopción de la dieta mediterránea en adultos chilenos con elementos diagnósticos del síndrome metabólico / Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome

Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menorprevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporanpropuestas de este patrón alimentario en su vida cotidiana.Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile.Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnósticode síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudesy las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo elenfoque de teoría fundada usando el softwar e ATLAS.ti.Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificaciónde algunos alimentos aislados) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunosalimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiereesfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas.Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clavepara diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para elenfrentamiento de las enfermedades crónicas en Chile.(AU)

Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lowerprevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals foradherence to this food pattern in their daily lives.Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile.Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterionof metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated withchanges and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out underthe grounded theory approach using the ATLAS.ti software.Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foodsitems) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routineadoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but alsorelational effort as it implies modifications of family and collective practices.Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implementnutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.(AU)

[Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome]. / Limitaciones y oportunidades para la adopción de la dieta mediterránea en adultos chilenos con elementos diagnósticos del síndrome metabólico.

Introduction: Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lower prevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals for adherence to this food pattern in their daily lives. Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile. Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterion of metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated with changes and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out under the grounded theory approach using the ATLAS.ti software. Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foods items) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routine adoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but also relational effort as it implies modifications of family and collective practices. Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implement nutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.

Introducción: Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menor prevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporan propuestas de este patrón alimentario en su vida cotidiana. Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile. Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnóstico de síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudes y las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo el enfoque de teoría fundada usando el software ATLAS.ti. Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificación de algunos alimentos aislados, dinámica familiar) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunos alimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiere esfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas. Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clave para diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para el enfrentamiento de las enfermedades crónicas en Chile.

[Improvement in adherence to Mediterranean diet in children attending preschool centers]. / Mejoría de la adherencia a la dieta mediterránea en preescolares asistentes al jardín infantil.

Introduction: Background: the Mediterranean diet has been associated with a lower prevalence of obesity and metabolic syndrome, and with healthier lifestyles in adults and children, but data is scarce in younger ages. The Mediterranean-type ecosystem of the central region of Chile as well as its traditional gastronomy would facilitate the adoption of this dietary pattern. Objectives: to assess the adherence to Mediterranean diet in preschoolers and their parents, and to evaluate the impact of a nutrition education intervention and diet implementation. Methods: prospective cohort study. The KidMed index was applied to children older than 18 months, and the Mediterranean Dietary Index in Chile (Chilean-MDI) to their parents, before and after a remote educational intervention. Results: one hundred and thirty-nine families participated, with 95 preschoolers; 56 % were girls, aged 26.2 ± 8.7 months. The basal mean KidMed score was 7.4 ± 1.9 and increased to 7.9 ± 1.9 after the intervention (p = 0.1). The Chilean-MDI score was 6.9 ± 1.8 and 7.1 ± 1.7, respectively (p = 0.09). When separated by categories, there was improvement from low and moderate adherence to optimal adherence in both children and their parents (Chi2, p = 0.009 y p = 0.04). In 58 dyads, there was a positive correlation between the KidMed and the Chilean-MDI index, pre- and post-intervention (Pearson R = 0.3 y 0.34; p = 0.004 y 0.003, respectively). Conclusions: most of these sample of preschoolers and their parents had a moderate adherence to Mediterranean diet, with an improvement after an educational intervention.

Introducción: Introducción: la dieta mediterránea se ha asociado a menor prevalencia de obesidad y síndrome metabólico y a estilos de vida saludable en adultos y escolares, siendo escasa la información en edades menores. La región central de Chile tiene un ecosistema de tipo mediterráneo, lo que, junto con su gastronomía tradicional, facilitaría la adopción de este estilo de alimentación. Objetivos: determinar la adherencia a la dieta mediterránea en preescolares y sus padres y evaluar el impacto de una intervención educativa y su implementación. Métodos: estudio de cohorte prospectiva. Se aplicaron los índices KidMed en niños/as mayores de 18 meses y el Índice Chileno de Dieta Mediterránea (IDM-Chile) en los padres, antes y después de una intervención educativa remota. Resultados: participaron 139 familias, con 95 preescolares, 56 % mujeres, con edad de 26,2 ± 8,7 meses. Inicialmente, el KidMed en los niños fue de 7,4 ± 1,9 puntos y aumentó hasta 7,9 ± 1,9 puntos postintervención (p = 0,1). El IDM-Chile en los padres fue de 6,9 ± 1,8 y 7,1 ± 1,7 puntos, respectivamente (p = 0,09). Al separar por categorías, hubo mejoría desde una adherencia baja o moderada hacia una óptima en los niños y adultos (Chi2, p = 0,009 y p = 0,04). En 58 diadas hubo una correlación positiva entre los índices KidMed e IDM-Chile preintervención y postintervención (R Pearson: 0,3 y 0,34; p = 0,004 y 0,003, respectivamente). Conclusiones: la mayoría de esta muestra de preescolares y sus padres presentaron una adherencia moderada a dieta mediterránea, con una mejoría posterior a la intervención educativa.

Healthy Eating as Potential Mediator of Inverse Association between Purpose in Life and Waist Circumference: Emerging Evidence from US and Chilean Cohorts.

High sense of purpose in life, a fundamental domain of eudaimonic well-being, has been consistently associated with lower risk for various obesity-related chronic diseases. Although this psychological feature correlates with some health behaviors as potential mediators, its association with healthy eating remains less explored. In addition, studies of these psycho-behavioral and health relationships in the South American population are lacking. This research sought to assess: (1) the cross-sectional association between self-reported purpose in life and overall healthy eating patterns, and (2) healthy food intake as a potential mediator of the inverse relationship between purpose in life and waist circumference. Data collected of 2060 US adults from the MIDUS study (5 ± 12 years, 55% women, mostly white people, and 42.5% obese) and 223 Chilean adults from the CHILEMED study (46.6 ± 9 years, 58.3% women, and 71.3% obese) were used. Anthropometric and sociodemographic variables were collected. Sense of purpose was assessed using the purpose in life subscale of the Ryff's psychological well-being questionnaire. Diet quality was evaluated using healthy eating or low-fat diet indexes, according to extant food intake data in each cohort. The relationship between these variables was estimated by bivariate and multivariate linear regressions with appropriate adjustments. To establish whether a better diet quality could mediate a link of purpose in life and improved nutritional status (assessed by waist circumference), the association between these three variables was tested by bootstrapping-based mediation analysis. Our results show significant associations of sense of purpose with healthy eating and low-fat dietary patterns in both US and Chilean cohorts, respectively, even after adjusting for sociodemographic variables. According to the mediation analysis, the relationship between sense of purpose and waist circumference, as an indicator of abdominal obesity, appears to be partially mediated by healthier food intake in both samples. In conclusion, our findings suggest a plausible mechanism underlying the favorable impact of this well-being dimension on physical health. Given its protective effects, interventions aimed at increasing purpose in life may facilitate adherence to better dietary patterns, which, in turn, will reduce the risk for obesity-related chronic diseases.

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial).

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

Race and sex differences in HDL peroxide content among American adults with and without type 2 diabetes.

BACKGROUND: High-density lipoprotein (HDL) plays a critical role in protection against atherosclerosic and cardiovascular disease (ASCVD). In addition to contributing to clearing excess vascular cholesterol, HDL particles exhibit antioxidative functions, helping to attenuate adverse effects of oxidized low-density lipoproteins. However, these beneficial properties can be undermined by oxidative stress, inflammation, and unhealthy lifestyles and diet, as well as influenced by race and sex. Thus, when assessing cardiovascular risk, it is important to consider multifactorial aspects of HDL, including antioxidant activity rather than just total amount and type of HDL-cholesterol (HDL-C) particles. Because prior research showed HDL peroxide content (HDLperox) can be inversely associated with normal anti-oxidant HDL activity, elevated HDLperox may serve as a bioindicator of HDL dysfunction. METHODS: In this study, data from a large national cohort of Americans was utilized to determine the impact of sex, race, and diabetes status on HDLperox in middle-aged and older adults. A previously developed cell-free fluorometric method was utilized to quantify HDLperox in serum depleted of apo-B containing lipoproteins. RESULTS: In keeping with predictions, white men and diabetics exhibited HDLperox in the atypical upper range, suggestive of less functional HDL. White men had higher HDLperox levels than African American males (13.46 ± 6.10 vs. 10.88 ± 5.81, p < .001). There was also a significant main effect of type 2 diabetes (F(1,1901) = 14.9, p < .0001). Overall, African Americans evinced lower HDLperox levels, despite more obesity (10.3 ± 4.7 vs.11.81 ± 5.66 for Whites) suggesting that other aspects of lipid metabolism and psychosocial factors account for the higher prevalence of ASCVD in African Americans. CONCLUSION: This research helps to provide a more comprehensive understanding of HDL function in a racially and metabolically diverse adult population. HDLperox content was significantly different in adults with type 2 diabetes, and distinctive in nondiabetic White males, and suggests other processes account for the higher prevalence of ASCVD among African Americans.

Reduced burnout and higher mindfulness in medical students after a self-care program during the COVID-19 pandemic.

BACKGROUND: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. AIM: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. MATERIAL AND METHODS: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. RESULTS: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. CONCLUSIONS: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.

Introducing Plant-Based Mediterranean Diet as a Lifestyle Medicine Approach in Latin America: Opportunities Within the Chilean Context.

Latin America is experiencing a significant epidemiological and nutritional transition, with a trend toward higher incidence of food-related chronic diseases. In this context, Lifestyle Medicine (LM) is a growing field focused on assisting individuals in adopting healthy behaviors for the prevention and treatment of these chronic diseases, including, among other pillars, a great emphasis on healthy eating. There is also a growing interest worldwide in environmental sustainability of dietary patterns, with increasing concern about their effects on planetary health. In this context, whole-food, plant-based diets -such as the Mediterranean diet (MD)- have emerged as a solution for both healthier eating and lowering environmental impact. Yet in order to be effective at these goals and achieve a high adherence to any nutritional prescription, the sociocultural reality of the community or population where we aim to practice must also be taken into account. In this review, we specifically highlight the plant-based MD as a LM-contextualized dietary pattern that is adaptable, applicable, and sustainable within the Chilean context and has the potential to address the current trend of chronic diseases in our country.

Intake of Vitamin E and C in Women of Reproductive Age: Results from the Latin American Study of Nutrition and Health (ELANS).

Vitamin E was identified as a lipophilic compound essential to maintain rat pregnancy. Low vitamin E intake during early pregnancy associates with congenital malformations and embryonic loss in animals and with miscarriage and intrauterine growth restriction in humans. Vitamin E protects cell membranes from lipoperoxidation and exerts non-antioxidant activities. Its function can be restored by vitamin C; thus, intake and circulating levels of both micronutrients are frequently analyzed together. Although substantial vitamin E inadequacy was reported worldwide, its consumption in Latin America (LatAm) is mostly unknown. Using data from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud, ELANS), we evaluated vitamin E and C intake in women of reproductive age (WRA) from eight LatAm countries and identified their main food sources. Two non-consecutive 24-h dietary recalls in 3704 women aged from 15 to 49 years and living in urban locations showed low average intake of vitamin E (7.9 mg/day vs. estimated average requirement (EAR) of 12 mg/day) and adequate overall vitamin C consumption (95.5 mg/day vs. EAR of 60 mg/day). The mean regional inadequacy was 89.6% for vitamin E and 36.3% for vitamin C. The primary food sources of vitamin E were fats and oils, as well as vegetables. Vitamin C intake was explained mainly by the consumption of fruit juices, fruits, and vegetables. Combined deficient intake of both vitamins was observed in 33.7% of LatAm women. Although the implications of low antioxidant vitamins' consumption in WRA are still unclear, the combined deficient intake of both vitamins observed in one-third of ELANS participants underscores the need for further research on this topic.

Association between serum sphingolipids and eudaimonic well-being in white U.S. adults.

Emerging research has linked psychological well-being with many physiological markers as well as morbidity and mortality. In this analysis, the relationship between components of eudaimonic well-being and serum sphingolipids levels was investigated using data from a large national survey of middle-aged American adults (Midlife in the United States). Health behaviors (i.e., diet, exercise, and sleep) were also examined as potential mediators of these relationships. Serum levels of total ceramides-the main molecular class of sphingolipids previously associated with several disease conditions-were inversely linked with environmental mastery. In addition, significant correlations were found between specific ceramide, dihydroceramide, and hexosylceramides species with environmental mastery, purpose in life, and self-acceptance. Using hierarchical regression and mediation analyses, health behaviors appeared to mediate these associations. However, the link between ceramides and environmental mastery was partially independent of health behaviors, suggesting the role of additional mediating factors. These findings point to sphingolipid metabolism as a novel pathway of health benefits associated with psychological well-being. In particular, having a sense of environmental mastery may promote restorative behaviors and benefit health via improved blood sphingolipid profiles.

Reduced burnout and higher mindfulness in medical students after a self-care program during the COVID-19 pandemic / Reducción del agotamiento en estudiantes de medicina mediante auto-cuidado durante la pandemia COVID-19

ABSTRACT Background: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. Aim: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. Material and Methods: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. Results: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. Conclusions: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.

Antecedentes: Los estudiantes de medicina experimentan altos niveles de estrés y burnout durante la formación clínica. Sin embargo, la mayoría de los planes de estudios médicos no enseñan habilidades de autocuidado. La pandemia de COVID-19 ha conmocionado la educación médica provocando mayor distrés entre los estudiantes. Objetivo: Informar sobre la implementación y el impacto de un programa multifacético de autocuidado -basado en mindfulness (atención consciente)-sobre el distrés y el bienestar de los estudiantes de medicina durante la pandemia de COVID-19. Material y Métodos: Ciento veintitrés estudiantes de medicina de cuarto año asistieron al programa como parte de un curso obligatorio de abril a mayo de 2020, durante la fase ascendente de COVID-19 en Chile. Fueron evaluados mediante pruebas validadas antes e inmediatamente después del programa. Las medidas incluyeron burnout, mindfulness disposicional, estrés percibido, reacciones de estrés traumático, bienestar general, resiliencia y estrategias de afrontamiento del estrés. Resultados: La prevalencia del burnout disminuyó del 48% al 24%, mientras que los estudiantes con alto mindfulness aumentaron del 25% al 44%. La reducción del burnout se debió principalmente a la disminución del agotamiento emocional. Además, los estudiantes informaron niveles más bajos de estrés, autoinculpación y reacciones de estrés traumático junto con un mayor uso de estrategias activas de afrontamiento y mayores niveles de resiliencia, después del programa de autocuidado. Conclusiones: Una intervención educativa formal que enseñe habilidades de autoconciencia y autorregulación puede ayudar a reducir el burnout de los estudiantes de medicina y promover su bienestar incluso en medio de una pandemia.

Lower versus standard sucrose dose for treating hypoglycemia in patients with type 1 diabetes mellitus in therapy with predictive low glucose suspend (PLGS) augmented insulin pumps: A randomized crossover trial in Santiago, Chile.

BACKGROUND AND AIMS: Recommended hypoglycemia treatment in adults with T1D consists of 15 g of rapid absorption carbohydrates. We aimed to evaluate the response to fewer carbohydrates for treating hypoglycemia in patients with T1D on insulin pumps with predictive suspension technology (PLGS). METHODS: T1D patients on insulin pumps with PLGS were randomized to receive 10 or 15 g of sucrose per hypoglycemia for two weeks (S10 and S15 groups, respectively) when capillary blood glucose (BG) was <70 mg/dL, with crossover after two weeks. Evolution of capillary BG, active insulin, and suspension time were assessed. RESULTS: 59 hypoglycemic episodes were analyzed, 33 in S10 and 26 in S15. Baseline BG in S10 was 54.3 ± 7.7 mg/dL versus 56.9 ± 8.8 in S15 (p = 0,239). Active insulin, present in 85% of the episodes, and PLGS suspension time were similar between groups. BG at 15 min was 77 mg/dL in S10 and 95 mg/dL in S15 (p = 0.0007). In S10, 21% of the episodes required to repeat the treatment after 15 min compared with none on S15, with a RR of 0,79 (95% CI 0.66, 0.940, p = 0,014) for successfully treating the episode. Sensor glucose was significantly different from BG at the moment of the hypoglycemia and control 15 min after treatment. No severe hypoglycemia and no rebound hyperglycemia occurred in neither group. CONCLUSIONS: A hypoglycemia treatment protocol with a lower dose of sucrose might be insufficient despite PLGS technology. Our data suggest that standard doses of sucrose should still be recommended.

Folate status in women of childbearing age in the Urban Metropolitan Region of Chile: results from the National Health Survey 2016-2017.

OBJECTIVE: To analyse serum folate levels in women of childbearing age in the Metropolitan Region (MR) of Chile. DESIGN: Cross-sectional design as part of the 2016-2017 National Health Survey (Encuesta Nacional de Salud, ENS 2016-2017), using a household-based multistage stratified random sample. Serum folate levels measured by electrochemiluminescence immunoassay in fasting venous blood samples were classified as deficient (<4·4 ng/ml), normal (4·4-20 ng/ml) or supraphysiological (>20 ng/ml). SETTING: The MR of Chile. PARTICIPANTS: Women of reproductive age (15-49 years, n 222) from the MR participated in the ENS 2016-2017. RESULTS: The mean, median and range of serum folate were 14·2 (se 0·4), 13·9 and 2·1-32·2 ng/ml, respectively. Folate deficiency was detected in 0·9 % of women, while 7·0 % had supraphysiological levels of the vitamin. No significant effects of age, educational level, marital status, parity, smoking status or nutritional status on serum folate levels were detected by univariate or multivariate analyses. Intake of folic acid supplements showed a significant association with serum folate levels, but only 1·2 % of women used supplements. CONCLUSIONS: Folate deficiency in women of reproductive age living in the MR of Chile is almost inexistent according to the ENS 2016-2017, suggesting that the current population-wide mandatory folic acid fortification of flour is an effective and equitable measure to prevent folate deficiency. These results support the option of maintaining current folic acid fortification in Chile, particularly based on the low adherence to supplementation regimes evidenced in other populations.

Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile.

Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.

Intake of Non-Nutritive Sweeteners in Chilean Children after Enforcement of a New Food Labeling Law that Regulates Added Sugar Content in Processed Foods.

After enforcement of a new food labeling law in 2016, Chile exhibits a greater offer to reduced sugar products with addition of non-nutritive sweeteners (NNS). Many of these products are consumed by children, who are at greater risk of reaching the acceptable daily intake (ADI) of these food additives. The objective of this study was to evaluate the intake levels of NNS in Chilean schoolchildren after the enactment of the aforementioned law. A total of 250 Chilean children 6-12 years old were surveyed. NNS intake was assessed through a food frequency questionnaire. All children evaluated consumed at least one NNS during the previous month. Sucralose had the highest consumption frequency reaching 99.2%, followed by acesulfame-K (92.8%), stevia (86.0%), and aspartame (85.2%). Aspartame showed the highest median intake, which came mainly from beverages (96%). No children exceeded the ADI of any NNS. Smaller children exhibited a higher body weight-adjusted intake of sucralose, acesulfame-K, stevia, and aspartame (p < 0.05). In Chile, a wide range of processed foods with NNSs is available and all schoolchildren evaluated consumed at least one product containing NNS. However, this consumption does not exceed defined ADIs for any of the six sweeteners authorized for food use in Chile.

Niveles de colesterol no HDL en la población chilena y su asociación con enfermedad cardiovascular y diabetes mellitus: estudio de corte transversal en Encuesta Nacional de Salud 2009-2010 / Non-HDL cholesterol levels in Chilean population and their association with diabetes mellitus and cardiovascular disease

Background Despite aggressive treatment aimed at lowering LDL cholesterol (LDL-C) levels with statins, there is a high residual prevalence of cardiovascular diseases, which may depend on plasma cholesterol transported in other atherogenic lipoproteins. Aims To describe non-HDL cholesterol (non-HDL-C) levels in the Chilean population and their association with diabetes mellitus and cardiovascular disease. To evaluate compliance with non-HDL-C therapeutic goals -according to individual cardiovascular risk- at different levels of triglycerides, in comparison with LDL-C goal achievement. Material and Methods: We analyzed data from 2,792 Chilean subjects aged ≥ 15 years who were included in the 2009-2010 National Health Survey and had valid data for blood lipids, diabetes, and cardiovascular disease. Results Forty five percent of subjects had high non-HDL-C levels. The proportion of diabetic and non-diabetic subjects with high non-HDL-C levels was 81 and 42%, respectively (p < 0.01). A significant discordance was observed in the achievement of therapeutic objectives when LDL-C or non-HDL-C levels were considered, particularly in presence of triglycerides ≥ 150 mg/dl. Namely, 8% of the population showed elevated levels of high non-HDL-C despite adequate LDL-C levels. Conclusions Evaluation and management of elevated non-HDL-C in patients with adequate levels of LDL-C seems worthwhile considering the discordance observed between these blood cholesterol fractions. This strategy may be effective to reduce the residual cardiovascular risk in the Chilean population.

Red Wine Grape Pomace Attenuates Atherosclerosis and Myocardial Damage and Increases Survival in Association with Improved Plasma Antioxidant Activity in a Murine Model of Lethal Ischemic Heart Disease.

A healthy dietary pattern and high quality nutrient intake reduce atherosclerotic cardiovascular disease risk. Red wine grape pomace (RWGP)-a rich natural source of dietary fiber and antioxidants-appears to be a potential functional food ingredient. The impact of a dietary supplementation with RWGP flour was evaluated in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice, a model of lethal ischemic heart disease. SR-B1 KO/ApoER61h/h mice were fed with atherogenic (high fat, cholesterol, and cholic acid, HFC) diet supplemented with: (a) 20% chow (HFC-Control), (b) 20% RWGP flour (HFC-RWGP), or (c) 10% chow/10% oat fiber (HFC-Fiber); and survival time was evaluated. In addition, SR-B1 KO/ApoER61h/h mice were fed for 7 or 14 days with HFC-Control or HFC-RWGP diets and plasma lipid levels, inflammation, oxidative damage, and antioxidant activity were measured. Atherosclerosis and myocardial damage were assessed by histology and magnetic resonance imaging, respectively. Supplementation with RWGP reduced premature death, changed TNF-α and IL-10 levels, and increased plasma antioxidant activity. Moreover, decreased atheromatous aortic and brachiocephalic plaque sizes and attenuated myocardial infarction and dysfunction were also observed. These results suggest that RWGP flour intake may be used as a non-pharmacological therapeutic approach, contributing to decreased progression of atherosclerosis, reduced coronary heart disease, and improved cardiovascular outcomes.

[Burnout in students of health-care professions. Risk and protection factors]. / Burnout en la formación de profesionales de la salud en Chile: Factores de protección y riesgo, y propuestas de abordaje desde la perspectiva de los educadores.

BACKGROUND: The burnout syndrome affects more than half of students and professionals involved in healthcare worldwide and is characterized by emotional exhaustion, depersonalization and a low perception of self-efficacy. Several studies indicate that when students are burnt-out, clinical work, professionalism and ethical behavior, as well as empathy, are negatively affected, while the risk of academic attrition, depression and suicidal ideation tend to increase. At a national level, recent information shows that one out of every two medical students suffer burnout at the beginning of the clinical cycle, a situation that does not improve after finishing undergraduate medical training. There is no consensus on which are the most appropriate strategies to face the problem of burnout in students and health-care professionals. Some studies indicate that the experience of medical and health educators may be key to the design of effective strategies to address this problem. AIM: To identify the burnout risk and protection factors of students at different medical schools. MATERIAL AND METHODS: In this study -in which 34 expert health educators from eight Chilean medical schools and other health-related schools participated- we used a qualitative methodology based on the appreciative inquiry to explore the key elements associated with the occurrence of burnout, identify protective and risk factors, as well as discuss possible effective interventions to prevent it. RESULTS: There are personal, academic and contextual elements that act as protective or risk factors of burnout. In addition, the educators identified key elements to design organizational and curricular interventions to face the problem of burnout at a local level. CONCLUSIONS: Burnout is a serious problem in the formation of health care professionals. Teacher training aimed at promoting student'well-being must include the teaching of communication skills that consider both the generation gap and the profile of the professional medical schools intend to form.

Assessment of Diet Quality in Chilean Urban Population through the Alternate Healthy Eating Index 2010: A Cross-Sectional Study.

Most worldwide causes of disease and death are strongly associated with dietary factors and the application of eating indexes has proved to be a useful tool to determine diet quality in populations. The aim of this study was to evaluate the diet quality in Chile through the application of the Alternate Healthy Eating Index 2010 (AHEI-2010). A representative sample (n = 879) of Chilean urban population aged 15⁻65 years old from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud; ELANS) was used. Dietary intake data were obtained through two 24-hour food recalls and one beverage frequency questionnaire, which were used to calculate AHEI-2010 and its association with sociodemographic and anthropometric variables. In this Chilean sample, the AHEI-2010 score was 43.7 ± 7.8 points (mean ± SD). Trans fats and sodium intake were the highest scoring AHEI-2010 components whereas sugar-sweetened beverages and whole grains had the lowest score. Women, older subjects, and individuals in medium-high socioeconomic levels had significantly higher mean AHEI-2010 scores. No association was found between AHEI-2010 and body mass index (BMI), or nutritional status. Conclusions: Diet quality in the Chilean urban population aged 15⁻65 years old is far from optimal. Thus, there is room for significant improvement of diet quality in Chile through design and implementation of public health policies, particularly in high-risk groups for chronic diseases.